Kerry Kennedy Meltzer: I’m treating too many young people for the coronavirus
Foer: You mentioned profit margins. Are you having to think about that in the middle of the crisis?
Horn: We’re moving 70 percent of our routine care to visual-based platforms and phone-based platforms. And, in a moment where what we want is people to be inspired to just do the right thing—whether that’s a phone call or a video visit, or an email—we are still having to spend much more time than I would want talking to our compliance team, our billing team, our general counsel, about, “Will phone visits be paid at the same rate as video visits?” For some payers, we’re already hearing it won’t. They’re going to pay a video visit more approximate to an in-person visit. But a telephone call with a patient, with a medical record open that actually replicates care and leads to really meaningful conversations, the payers are like, “Yeah, that’s got to be paid out at a discounted rate,” in this moment is, to me, a very concerning thing.
More importantly, smart people in hospitals are having to spend their time leading us through this, in a moment of crisis, instead of focusing their talents elsewhere. It’s just an interesting moment to reflect on the fact that we don’t have universal health care. We don’t have what we call a model, where primary-care networks are paid to care for the population, in whatever way they need to.
Foer: It’s one of the insane paradoxes of modern medicine: It seems like hospitals will never have been so busy, yet the whole experience will deplete their revenue streams and actually make it so a bunch of doctors are going to get paid less money.
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Horn: Like I said, my dad is an anesthesiologist in Virginia, in a community hospital, and they took a much longer time than we did to cancel elective surgeries. And the reason that they took a longer time to cancel elective surgeries, in my opinion, is because without the surgeries, they don’t get paid. And so, right now, when he’s not needed in the operating room because there are so few surgeries, he’s furloughed. I’m very grateful for that, because he’s an older physician, and I’m grateful that he’s not working. But again, that’s not a good safety net for our doctors. I know the rest of society is feeling very parallel things, and doctors are in very fortunate positions. But again, just an interesting reflection on our health-care system.
Oh, you asked about reasons for optimism. I have one inspirational thing.
Foer: Hit me.
Horn: I wrote an op-ed about how the U.S. could avoid Italy’s ventilator crisis. The phone number for my clinic had to get shut down for a day, after the piece, because people were so desperate to try to reach out to offer their ideas, that they were calling my patient-care line, and patients couldn’t get through. So that was not a good scene. But, what’s happening is—and it’s not my doing, by any stretch—but there’s a hackathon in Boston this weekend [to create a rapidly deployable mechanical ventilator within 90 days]. A virtual hackathon, that has over 1,000 participants, and is sponsored by numerous big tech companies and large corporations.
[That people and] large firms want to step up is really inspirational. But I would just simply say that at Mass General we were told, “We need four new clinics opened, to care for patients of respiratory illness, within two weeks. Get it done, and let us know what you need to get it done.” And that is not the way this ventilator crisis is being handled. And I think in retrospect, that will be seen as one of the major oversights in the history of managing disasters in our country.